Capital Region Health Park
711 Troy-Schenectady Road
Latham, New York 12110

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Hypertension, or high blood pressure, affects almost 25% of the population of the United States.  Most of these patients have Essential Hypertension, which means that no cause can be found to explain their increase in blood pressure.  However, 3-8% of patients with hypertension may have high blood pressure that is caused by vascular disease.  In this particular case, the vascular disease involves the renal arteries, which are the arteries responsible for bringing blood to the kidneys.  These blockages are caused by atherosclerosis, or hardening of the arteries, within the renal arteries. 

Atherosclerosis occurs when plaque, which is made of fat and cholesterol, builds up within the wall of the renal artery.  This reduces the amount of blood that can flow through the affected artery into the kidney. The kidney is able to sense the reduction in blood flow and responds by producing a hormone that ultimately results in an increase in blood pressure.  When hypertension is caused by a blockage of the renal artery, it is known as Renovascular Hypertension.

Renal artery blockages can also occur in association with a disease called Fibromuscular Dysplasia.  This is a congenital abnormality affecting the wall of blood vessels that can lead to both narrowing and the formation of small aneurysms.  It is seen most commonly in young female patients.

A blockage in the renal artery should be suspected when patients develop high blood pressure either before the age of 30 years or after the age of 50 years.  In addition, it should also be suspected when stable hypertension suddenly becomes more difficult to treat with medication.  It is important to address blockages in the renal arteries because they can become more severe in time.  At some point, a blockage can become severe enough to affect the function of the kidneys.

Diagnosis of Renovascular Hypertension

1. Ultrasound: Ultrasound is a non-invasive test that can be used to detect a blockage in the renal arteries.  This test relies on direct visualization of the renal arteries and the abdominal aorta, from which the renal arteries arise.  During this test, measurements of blood flow in the aorta and renal arteries are made.  If the velocity of blood flow within the renal arteries is increased and if the flow within the vessel is abnormal, then a diagnosis of renal artery stenosis can be made.
   
   
2. Magnetic Resonance Angiography (MRA): This test uses an MRI scanner to obtain pictures of the renal arteries.  By directly visualizing the renal arteries, it is possibly to determine how extensive and how severe the blockages are, which will help determine if treatment is appropriate for an individual patient.  In order to visualize the arteries, contrast material or dye containing gadolinium is used.  It is important to tell us at the time of this test if you have any history of kidney disease since gadolinium may not be safe to use if that is the case.
   
   
3. Computed Tomography Angiography (CTA): This test is similar to an MRA but uses a CAT scan machine to obtain the pictures of the renal arteries.  In order to visualize the arteries, contrast material or dye containing iodine is used.  It is important to tell us at the time of this test if you have any history of kidney disease since the dye can compromise kidney function.

Interventional Treatment of Renovascular Hypertension

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